加味参苓白术散对持续性不卧床腹膜透析患者胃肠功能障碍及蛋白质-能量消耗的干预作用  

Effect of Modified Shenling Baizhusan on Gastrointestinal Dysfunction and Protein-energy Wasting in Continuous Ambulatory Peritoneal Dialysis Patients

作　　者：吕勇[1] 鲍容 张磊[1] 王东[1] 任克军[1] 王亿平[1] LYU Yong;BAO Rong;ZHANG Lei;WANG Dong;REN Ke-jun;WANG Yi-ping(The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院,合肥230031

出　　处：《中国实验方剂学杂志》2022年第3期116-122,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：第四批全国中医临床优秀人才研修项目(国中医药办人教发〔2017〕124号);安徽中医药大学第一附属医院临床科学研究项目(2020yfyzc13);国家自然科学基金面上项目(81673931)。

摘　　要：目的:观察和分析加味参苓白术散对持续性不卧床腹膜透析(CAPD)脾虚挟瘀浊证患者胃肠功能障碍及蛋白质-能量消耗(PEW)的干预作用。方法:CAPD脾虚挟瘀浊证患者66例,随机分为观察组和对照组各33例,每组3例患者退出观察,实际完成60例。两组均予CAPD和常规对症治疗,观察组服用加味参苓白术散颗粒(1剂/d,分早晚2次服),对照组口服双歧杆菌二联活菌胶囊(1.05 g/次,每日2次),疗程12周。观察两组患者治疗前后中医证候积分值、胃肠道症状分级量表(GSRS)评分、营养不良-微炎症(MIS)评分的变化;检测患者血清白蛋白(ALB),前白蛋白(PA),转铁蛋白(TRF),胃泌素-17(G-17),血清肿瘤坏死因子-α(TNF-α),γ干扰素(IFN-γ)和白细胞介素-10(IL^(-1)0)水平,计算体质指数(BMI)的变化情况。结果:治疗后观察组中医证候疗效优于对照组(Z=-2.591,P<0.05),中医证候积分明显下降(P<0.05)。与本组治疗前及对照组治疗后比较,观察组各主要症状积分,MIS评分和G-17均明显下降(P<0.05)。与本组治疗前比较,两组GSRS评分值明显下降(P<0.05),观察组比对照组降低幅度大(P<0.05)。与本组治疗前及对照组治疗后比较,观察组ALB,PA,TRF和BMI均明显升高(P<0.05)。与本组治疗前比较,两组患者血清TNF-α,IFN-γ均明显下降(P<0.05)。与本组治疗前及对照组治疗后比较,观察组IL^(-1)0水平明显升高(P<0.05)。结论:加味参苓白术散可改善CAPD脾虚挟瘀浊证患者胃肠功能障碍和PEW。Objective:To observe and analyze the effect of modified Shenling Baizhusan on gastrointestinal dysfunction and protein-energy wasting(PEW)of continuous ambulatory peritoneal dialysis(CAPD)patients with the syndrome of spleen deficiency,blood stasis,and dampness.Method:A total of 66 CAPD patients with the above syndrome were randomized into the observation group and control group,33 cases in each group.However,3 cases in each group dropped out,finally leaving 30 cases in each group.Both groups received CAPD and conventional symptomatic treatment.On this basis,the observation group was given modified Shenling Baizhusan(1 bag/day,once in the morning and again in the evening,12 weeks),and the control group the bifidobacterium capsules(1.05 g/time,twice/day,12 weeks).Before and after treatment,the traditional Chinese medicine(TCM)syndrome score,gastrointestinal symptom rating scale(GSRS)score,and malnutrition-inflammation score(MIS)in two groups were recorded,and the levels of serum albumin(ALB),prealbumin(PA),transferrin(TRF),gastrin-17(G-17),tumor necrosis factor alpha(TNF-α),interferon-γ(IFN-γ),and interleukin-10(IL^(-1)0)were detected.Moreover,body mass index(BMI)was calculated.Result:After treatment,the alleviation of the TCM syndrome in the observation group was better than that in the control group(Z=-2.591,P<0.05),and the TCM syndrome score in the observation group was lower than that in the control(P<0.05).The symptom scores,MIS,and G-17 of the observation group were significantly decreased compared with those before observation and in the control group(P<0.05).After treatment,the GSRS scores of the two groups were significantly lower than those before treatment(P<0.05),particularly the observation group(P<0.05).ALB,PA,TRF,and BMI of the observation group after treatment were increased compared with those before treatment and those of the control group after treatment(P<0.05).After treatment,serum TNF-αand IFN-γof the two groups were significantly reduced compared with those before treatment(P<0.05),and

关 键 词：持续性不卧床腹膜透析 加味参苓白术散 胃肠功能障碍 蛋白质-能量消耗 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]